HOW  MUCH  SHOULD 


PONTIAC  PH  ITS  HEALTH  OFFICER? 


BY 

HENRY  B.  BAKER, 

Secretary  of  the  State  Board  of  Health, 
LANSING,  MICH. 


Address  delivered  at  the  Pontiac  Sanitary  Convention, 

October  i 8,  1889. 


[Reprint  No.  321.] 


HOW  MUCH  SHOULD  PONTIAC  PAY  ITS  HEALTH  OFFICES? 


BY  HENRY  B.  BAKER,  M.  D.,  SECRETARY  OF  THE  STATE  BOARD  OF  HEALTH, 

LANSING,  MICH. 


[Reprinted  from  the  Report  of  Proceedings  at  the  Pontiac  Sanitary  Convention.— Oct,  1889, 
Supplement  to  the  Report  of  the  State  Board  of  Health,  1890.] 

[Reprint  No. 321.] 


I presume  that  most  persons  in  this  audience  have  formed  an  idea  as  to 
how  much  Pontiac  should  pay  its  health  officer,  yet  probably  your  opinions 
differ  greatly  as  to  what  is  the  proper  amount.  Perhaps  some  would  say  it 
should  be  the  smallest  amount  for  which  any  physician  would  consent  to 
occupy  the  position.  I venture  to  suggest  that  that  is  a very  short-sighted 
view  to  take  of  the  subject.  Because  it  has  come  to  be  well  known  that 
many  of  our  most  fatal  diseases  can  be  prevented,  especially  those  diseases 
which  cause  the  great  majority  of  what  we  call  premature  deaths — those 
among  children  and  among  people  in  the  prime  of  life.  From  facts  col- 
lected in  our  own  State  we  know  that  in  those  localities  where  there  is  a 
good  and  efficient  health  officer-,  and  where  the  people  intelligently  cooperate 
with  him  for  the  restriction  of  dangerous  communicable  diseases,  there  are 
not  more  than  one-fifth  or  one-fourth  of  the  number  of  cases  or  deaths  from 
such  dangerous  diseases  as  scarlet  fever  and  diphtheria  as  there  are  in  local- 
ities in  which  such  methods  of  restriction  and  prevention  are  not  carried 
out.  Let  us  study  this  important  fact  until  we  fully  understand  it,  because 
it  means  that  three-fourths  or  four-fifths  of  all  the  sickness  and  deaths  from 
those  diseases  can  be  prevented.  It  means  that  we  know  exactly  how  to 
prevent  that  large  proportion  of  the  sickness  and  of  the  deaths.  Are  you 
willing  to  permit  a continuance  of  sickness  and  deaths  from  diseases  that 
are  known  to  be  in  great  part  preventable? 

An  important  fact  in  this  connection  is  that,  although  these  diseases  are 
preventable,  their  prevention  cannot  be  accomplished  except  by  the  gen- 
eral cooperation  of  the  people  of  the  city, — it  is  essential  that  there  shall  be 
a prompt  and  efficient  health  officer,  and  then  it  is  essential  that  the  people 
generally  shall  intelligently  and  faithfully  aid  him  in  the  good  work.  Three 
of  these  dangerous  communicable  diseases  are  now  present  in  Pontiac,  and 
they  cannot  be  restricted  except  the  people  of  Pontiac  will  thoroughly 
cooperate  with  the  health  officer  for  their  restriction.  For  the  best  work 
for  the  restriction  of  disease,  it  is  essential  that  the  health  department  of 
the  city  shall  be  so  organized  that  it  can  act  at  a moment’s  notice, — its 
action  should  be  even  more  prompt  than  is  the  action  of  the  fire  depart- 
ment, because  in  the  case  of  fire  there  is  usually  only  property  at  risk,  whereas 
in  the  case  of  dangerous  communicable  disease  it  is  a question  of  life  or 
death , and  perhaps  to  many  persons.  In  order  that  a health  officer  can 
always  be  thus  prepared,  and  always  act  thus  promptly,  his  whole  time  and 
thought  and  study  must  be  given  to  the  subject;  it  will  not  do  to  wait  for 


HOW  MUCH  SHOULD  PONTIAC  PAY  ITS  HEALTH  OFFICER? 


113 


his  action  while  he  is  attending  to  some  lingering  case : it  will  not  do  to 
have  his  thoughts  and  studies  mostly  given  to  the  treatment  of  sickness ; he 
should  employ  all  his  time  in  studying  how  to  prevent  sickness  and  in 
actual  work  for  its  prevention  or  restriction.  How  much  is  all  of  his  time 
worth?  It  is  worth  rather  more  than  the  income  of  the  most  prominent 
and  successful  practicing  physician  in  the  city ; because  sanitary  science  is 
one  of  the  highest  and  most  important  sciences,  and  requires  abilities  of  a 
high  order,  and  because  this  service  of  the  people  for  the  saving  of  their 
lives  and  health  is  the  noblest  service,  and  because  it  is  greatly  against  pub- 
lic policy  to  permit  any  class  of  persons,  even  so  high  and  noble  a class  as 
the  medical  profession,  to  have  a money  interest  in  having  sickness  prevail, 
greater  than  the  money  interest  of  any  other  class  that  health  prevail. 
This  last  suggestion  may  perhaps  be  more  clearly  made  by  a few  words  of 
explanation : In  the  minds  of  most  persons  there  is  a feeling  that  the  rela- 

tions which  the  medical  profession  sustains  to  the  people  are  not  just  what 
they  should  be,  that  in  some  way  the  doctor  ought  to  have  a money  interest 
in  getting  and  keeping  his  patients  well,  and  not  have  his  pay  stop  just  as 
soon  as  they  recover.  Under  present  relations  his  interests  are,  in  this 
respect,  apparently,  antagonistic  to  the  interests  of  the  people.  This  feel- 
ing has  found  expression  in  the  stories,  which  are,  possibly,  ideal,  about  how 
much  better  such  relations  are  in  some  far  off  country  about  which  little  is 
known.  Before  we  knew  so  much  about  China  we  used  to  hear  that  in 
China  the  doctor  was  paid  so  long  as  the  patron  was  well,  and  his  pay 
stopped  as  soon  as  the  patron  was  sick.  I hope  it  is  true.  And  Dr. 
Rhodes  told  us  this  afternoon  that  that  method  is  in  practice  in  the  Upper 
Peninsula  of  our  own  State.  But  without  dwelling  more  on  this  point,  I 
want  to  urge  the  very  great  importance  of  making  it  for  the  money  interest 
of  at  least  one  of  the  most  intelligent  and  faithful  physicians  in  the  city 
that  health  shall  prevail.  The  law  requires  that  the  city  shall  have  a health 
officer  “who  shall  be  a well-educated  physician.”  In  such  a city  as  Pontiac 
the  law  should  require  that  his  entire  time  shall  be  devoted  to  the  work, 
because  the  highest  interests  in  the  city  demand  that  this  shall  be  done. 
Then,  of  course,  he  should  be  paid  for  his  entire  time. 

Prom  one  standpoint,  then,  we  have  learned  approximately  how  much 
Pontiac  should  pay  its  health  officer — that  is,  we  would  know  if  we  knew 
how  much  the  most  successful  physician  in  the  city  can  collect.  The  health 
officer  should  be  paid  just  a little. more,  for  reasons  already  stated,  and  for 
the  additional  reason  that  all  official  positions  are  more  or  less  insecure, 
and  no  physician  could  afford  to  give  up  his  profession  to  engage  in  work 
which,  to  some  extent,  might  unfit  him  for  it,  and  run  the  risk  of  losing 
the  position  in  a year  or  in  a few  years.  This  suggests  also  the  fact  that 
each  year  he  is  health  officer  he  is  gaining  knowledge  especially  useful  to 
the  people,  therefore,  a good  health  officer  should  be  continued  in  office. 
We  may  say,  then,  that  he  should  receive  at  least  two  thousand  dollars  per 
year. 

HOW  MUCH  CAN  THE  CITY  AFFORD  TO  PAY? 

It  seems  to  me  that  the  city  can  afford  to  pay  for  health  and  life-saving 
service  about  as  much  as  its  people  will  save  by  having  such  a service ; and 
I think  we  now  have  facts  enough  to  prove  that  a very  considerable  saving 


114 


PONTIAC  SANITARY  CONVENTION,  OCT.,  1889. 


is  possible.  Let  us  examine  the  facts,  first  as  to  the  losses,  then  as  to  how 
much  can  be  saved. 

The  average  death-rate  in  Michigan,  when  not  specially  influenced,  is 
about  seventeen  per  thousand  inhabitants.  Let  us  estimate  the  inhabitants 
of  Pontiac  at  six  thousand.  Then  from  this  time  forward  there  would 
naturally  be  in  this  city  102  deaths  per  year,  from  all  causes.  As  I have 
before  suggested,  some  of  those  ordinary  causes  of  deaths  are  preventable ; 
that  is  to  say  three-fourths  of  the  cases  and  of  the  deaths  from  certain  dis- 
eases do  not  occur  where  first  and  subsequent  cases  are  promptly  isolated 
and  all  infected  things  are  thoroughly  disinfected.  What  proportion  of  the 
total  deaths  are  from  these  preventable  diseases?  Consumption  is  much  the 
most  important  disease,  and  causes  nearly  twelve  per  cent  of  all  deaths  in 
Michigan,  but  for  my  present  purposes  I am  not  going  to  consider  it.  The 
usual  proportion  of  the  deaths  attributable  to  three  other  diseases  known  to 
be  preventable  are  as  follows:  diphtheria,  6.5  per  cent;  scarlet  fever,  2.7 
per  cent ; and  typhoid  fever  3.2  per  cent  of  all  deaths.*  At  this  rate,  in  the 
six  thousand  people  which  are  to  be  in  Pontiac,  there  would  ordinarily  be 
in  a year,  on  the  average,  about  seven  deaths  from  diphtheria,  about  three 
from  scarlet  fever,  and  three  from  typhoid  fever,  f 

Reliable  statistics,  collected  by  the  Michigan  State  Board  of  Health,  have 
proved  that  (even  after  the  disease  is  introduced)  about  seventy-five  or 

'The  number  of  reported  deaths , from  all  causes,  in  Michigan  during  the  thirteen  years, 
1874-86 ; also  the  number  of  reported  deaths  from  Consumption,  Diphtheria,  Scarlet 
Fever  and  Typhoid  Fever,  during  the  same  period,  and  what  the  per  cent  of  deaths 
from  each,  and  from  all  of  these  four  diseases  is  of  the  deaths  from  all  causes. 

[Compiled  from  Registration  Reports  of  Michigan.] 


All  Deaths. 

Sum  of  Deaths  from 
the  four  Diseases. 

Consumption. 

Diphtheria. 

Scarlet  Fever. 

Typhoid  Fever. 

198,718 

48,253 

23,496 

12,948 

5,423 

6,386 

Per  cent 

24.3 

11.8 

6.5 

2.7 

3.2 

By  the  above  it  will  be  seen  that  3.2  per  cent  of  all  the  deaths  have  been  from  typhoid  fever,  2.7 
per  cent  from  scarlet  fever,  6.5  per  cent  from  diphtheria,  and  11.8  per  cent  from  consumption  ; and 
that  24.3  per  eent  of  all  the  deaths  have  been  from  these  four  diseases,  which  are  now  be^eved  to  be 
in  great  part  preventable  by  measures  which  are  practicable  by  intelligent  people  in  connection 
with  the  services  of  an  intelligent  and  efficient  local  health  officer  cooperating  with  a State  Board 
of  Health. 


+ Estimated  saving  of  life  which  might  be  accomplished  in  Pontiac,  Mich. , from  the  three 
diseases,  Diphtheria,  Scarlet  Fever  and  Typhoid  Fever. 


Diseases. 

Per  cent  of  Deaths 
in  Michigan  per 
annum  from  each 
of  the  three  Dis- 
eases. 

Deaths  in  Pontiac 
per  annum  from* 
each  of  the  three 
Diseases. 

Deaths  in  Pontiac 
which  might  he 
saved  each  year 
from  each  of  these 
three  Diseases,  at 
the  rate  of  seventy- 
five  per  cent. 

Diphtheria 

6.5 

6.63 

4.98 

Scarlet  Fever 

2.7 

2.75 

2.06 

Typhoid  Fever 

3.2 

3 26 

2.45 

HOW  MUCH  SHOULD  PONTIAC  PAY  ITS  HEALTH  OFFICER?  115 


eighty  per  cent  of  the  deaths  from  diphtheria  and  from  scarlet  fever  are 
prevented  by  thorough  isolation  of  all  infected  persons,  and  the  thorough 
disinfection  of  infected  persons,  things,  and  places,  therefore  the  thorough 
enforcement  of  these  measures,  will  save,  in  each  year,  in  this  city,  or  at 
least  in  the  average  city  the  size  of  Pontiac,  about  five  persons  from  death 
by  diphtheria,  about  two  persons  from  death  by  scarlet  fever,  and  I think 
also,  two  persons  from  death  by  typhoid  fever.  Surely  the  saving  of  these 
lives  is  well  worthy  the  effort  of  your  people.  It  cannot  with  certainty  be 
done  except  by  general  and  organized  cooperation  among  you.  In  other 
words,  you  cannot  do  it  without  an  efficient  health  officer;  and  then  you 
must  aid  him  to  the  extent  required  by  the  laws  of  the  State.  If,  however, 
you  maintain  an  efficient  health  officer,  and  otherwise  comply  with  the  laws, 
and  act  in  accordance  with  the  recommendations  of  the  State  Board  of 
Health,  you  can  certainly  save  these  lives. 

If  you  really  desire  to  do  it,  the  plans  of  procedure  are  all  worked  out, 
and  most  of  them  are  embodied  in  State  laws.  The  measures  applicable  to 
each  of  these  diseases  are  carefully  explained  in  the  several  pamphlets  which 
the  State  Board  of  Health  has  issued,  and  which  are  distributed  in  this 
audience.  Some  of  you  are  already  familiar  with  these  methods,  and  I 
hope  that  all  of  you  will  soon  become  familiar  with  them,  and  that  there 
will  be  such  a thorough  support  of  your  health  officer,  and  such  a strong 
public  opinion  as  will  hold  him  steadfastly  to  his  duties,  and  such  as  will 
pay  him  so  well  for  his  services  that  he  can  afford  to  do  his  best  for  the  pre- 
vention of  disease,  leaving  to  other  physicians  the  care  for  those  already 
sick. 

Of  course  I believe  that  lives  can  be  saved  from  other  diseases  than  those 
which  I have  just  mentioned;  but  I have  mentioned  diphtheria  and  scarlet 
fever  because  in  those  diseases  we  have  the  absolute  proof  that  lives  can  be 
saved  by  measures  that  are  well  known  to  us,  and  which  can  be  summarized 
in  three  words — “ isolation  and  disinfection. ” 

What  is  the  value  of  the  lives  which  may  be  saved?  When  lives  of  young 
persons  are  lost  to  a community  something  else  is  lost,  namely,  their  pros- 
pective earnings, — the  wealth  which  otherwise  they  would  have  created. 
There  are  several  ways  of  estimating  this  loss.  As  mentioned  by  the  Gov- 
ernor last  evening,  a few  years  ago  a good  negro  slave  was  valued,  for  what 
he  would  earn  in  excess  of  his  keeping,  at  about  eight  hundred  dollars ; and 
statisticians  usually  value  a person  in  the  prime  of  life  as  worth  to  the  com- 
munity about  one  thousand  dollars. 

Children  are  worth  as  much  less  as  it  will  cost  to  raise  them  to  the  most 
productive  age.  But  if  the  seven  children,  which  in  the  average  place  the 
size  of  Pontiac  should  be  saved  each  year  from  diphtheria  and  scarlet  fever, 
are  worth  only  half  the  price  of  a grown  person,  there  is  a saving  of  three 
thousand  five  hundred  dollars  a year  from  these  two  diseases  alone.  If  two 
lives  are  saved  each  year  from  typhoid  fever,  by  disinfection  of  infected 
matters  wherever  there  is  a case,  and  by  other  methods  which  a good  health 
officer  could  teach,  the  persons  saved  will  ordinarily  be  in  the  prime  of  life, 
and  this  saving  should  be  counted  as  two  thousand  dollars.  There  is,  then, 
“in  sight,’ ’ as  it  were,  a saving  of  five  thousand  five  hundred  dollars  a year 
in  Pontiac  by  such  work  as  can  be  done  by  and  in  connection  with  an  effi- 
cient health  officer,  with  reference  to  three  of  the  dangerous  communicable 
diseases.  Or,  to  put  the  subject  in  another  light,  if  this  city  were  to  expend 


116 


PONTIAC  SANITARY  CONVENTION,  OCT.,  1889. 


five  thousand  five  hundred  dollars  a year  in  the  exact  way  in  which  I have- 
indicated,  it  would  not  lose  money  thereby, — it  would  only  be  paying,  to 
the  health  officer  and  a few  others,  as  much  as  without  such  payments,  is, 
as  I believe,  actually  lost  to  the  people  of  Pontiac.  Is  it  not  better  to  pay 
money  for  public-health  services  than  to  bury  that  of  as  much  money  value 
in  the  graveyard? 

We  will  admit,  if  you  please,  that  when  deaths  occur,  the  loss  is  not  equally 
distributed  among  the  people  of  the  city;  generally  the  loss  falls  most 
heavily  upon  the  bereaved  family ; and  this  is  especially  true  if  the  death  is 
of  the  bread-winner  of  the  family.  But  it  should  not  require  much  argu- 
ment to  show  that  the  prosperity  of  a city  depends  greatly  upon  its  health- 
fulness and  the  safety  of  life  therein,  and  that,  in  a long  series  of  years,  the 
deaths  are  distributed  somewhat  equally  among  the  people,  and  that,  even 
if  they  were  not  equally  distributed,  a high  moral  sentiment  should  prompt 
us  to  guard  the  common  safety  of  life  among  us.  It  was  recognized  even 
before  the  Declaration  of  Independence,  that  to  each  citizen  the  right  to 
exist, — the  life  of  the  individual  is  among  the  inalienable  rights  to  secure 
which  “governments  are  instituted  among  men.”  It  is  plain,  therefore, 
that  one  of  the  highest,  perhaps  the  very  highest  function  of  a government 
is  to  guard  the  lives  of  the  people. 

Having  reference,  then,  to  only  three  of  the  most  important  diseases,  it 
seems  plain  to  me  that  a city  the  size  of  Pontiac  has  the  undoubted  right  to 
expend  in  every  year  five  thousand  five  hundred  dollars  for  the  restriction 
and  prevention  of  diphtheria,  scarlet  fever  and  typhoid  fever.  I think  that 
there  is  good  reason  to  believe  that  the  citizens  of  Pontiac  would  make 
money  by  this  work ; because  they  would  incidentally  save  lives  and  cases  of 
sickness  from  other  diseases  than  those  I have  mentioned ; and,  besides,  in 
my  account  of  the  losses  by  those  three  diseases,  I accounted  only  for  the 
losses  by  reason  of  the  deaths,  leaving  out  of  the  account  all  the  great 
expenses  for  the  sickness.  For  instance,  from  the  two  diseases,  diphtheria 
and  scarlet  fever  alone,  an  efficient  health  service,  properly  supported, 
should  in  each  year,  save  all  the  expenses  incident  to  forty-three  cases  of 
dangerous  sickness.*  All  such  saving  would  be  clear  profit,  in  case  the 
city  expend  the  five  thousand  five  hundred  dollars  per  year,  as  previously 
suggested,  and  save  five  thousand  five  hundred  dollars  worth  of  lives,  as  I 
have  shown  may  reasonably  be  expected. 

We  have  seen,  then,  that  the  health  officer  should  receive  at  least  two  thou- 
sand dollars  a year ; and  we  have  now  learned  that  the  city  can  well  afford 
to  pay  for  sanitary  purposes  connected  with  three  diseases,  at  least  five  thou- 
sand five  hundred  dollars  per  year.  Of  the  three  thousand  five  hundred 
dollars  per  year,  left  after  paying  the  health  officer,  I would  advise  that  at 
least  one  thousand  dollars  per  year  should  be  expended  toward  securing  a 
water-supply  which  is  above  suspicion.  This  with  special  reference  to  the 
prevention  of  typhoid  fever.  I would  use  another  thousand  per  year  toward 
securing  good  sewerage,  and  a proper  disposal  of  waste.  The  remaining 
five  hundred  dollars  would  pay  for  disinfectants,  for  printing  annual  and 

*The  reports  compiled  by  the  Michigan  State  Board  of  Health  show  that  for  each  death  from 
scarlet  fever,  there  are  over  ten  cases  of  sickness  from  that  disease;  that  for  each  death  from  diph- 
theria there  are  four  cases  of  sickness  from  diphtheria.  Therefore  the  seven  deaths  on  an  average 
yearly  from  diphtheria  in  the  average  place  the  size  of  Pontiac,  should  represent  twenty-eight  cases 
of  sickness,  and  the  three  deaths  from  scarlet  fever  represent  thirty  cases  of  scarlet  fever,— 58  cases 
from  the  two  diseases;  and,  inasmuch  as  seventy-five  per  cent  of  them  should  be  prevented  by  an 
efficient  health  service,  forty-three  of  the  cases  should  not  occur. 


HOW  MUCH  SHOULD  PONTIAC  PAY  ITS  HEALTH  OFFICER?  117 


other  reports  of  sanitary  officials,  including  the  water  and  sewerage  commis- 
sioners; and  for  other  incidental  expenses. 

The  city  of  Detroit  pays  its  health  officer  three  thousand  dollars  per  year, 
and  employs  and  pays  for  the  services  of  clerks  and  sanitary  police  officers. 
But  as  a rule  the  cities  in  Michigan  do  not  seem  to  have  awakened  to  the 
importance  of  the  subject.  Communities  have  grown  to  be  villages  and  vil- 
lages into  cities  so  gradually  that  the  dangers  which  come  to  people  because 
of  their  close  aggregation  have  not  attracted  the  attention  to  which  their 
importance  should  entitle  them.  The  health  officers  themselves  know  very 
well  that  they  are  not  doing,  and,  as  they  are  now  paid,  cannot  afford  to  do 
what  should  be  done  to  protect  the  lives  and  health  of.  the  people  under 
their  care.  Although  the  health  officers  say  little  about  it  in  their  respective 
localities,  it  is  not  difficult  for  us  at  Lansing  to  learn  how  they  feel  about 
their  compensation,  and  why  they  do  not  do  what  they  know  should  be  done. 
The  following  letter  illustrates  how  some  of  them  really  feel : 

“ -,  Oct.  14,  1889. 

“ Secretary , State  Board  of  Health,  Lansing,  Mich. 

“Esteemed  Sir: — Yours  of  the  twelfth  inst.  at  hand.  Fully  realizing 
my  duties  as  health  officer,  first  to  the  individual  families,  second  to  the 
community,  and  third  to  the  State,  how  can  I be  expected  to  do  all  I should? 
The  duties  to  the  State  require  considerable  clerical  work  and  other  atten- 
tion which  I do  neglect,  and  why?  Simply  because  since  March  4th,  1889,  I 
have  done  for  the  village  what  a private  person  would  be  obliged  to  pay 
about  $128.00  for,  and  have  shirked  all  I could  then,  and  perform  my  duties 
to  family  and  community  and  totally  neglect  my  duties  to  your  office,  because 
I receive  from  this  village  of  3,500  inhabitants  $75  per  year.  Do  you  blame 
me?” 

[Signed]  “ , M.  D., 

Health  officer.” 

This  health  officer  admits  that  he  has  “shirked  all  he  could”  and  yet  has 
earned  about  three  times  as  much  as  his  salary.  It  is  easy  to  preach  to  such 
an  officer  that  he  has  taken  a solemn  official  oath  to  perform  the  duties  of 
his  office  according  to  the  best  of  his  ability,  and  that  if  he  will  not  do  that 
he  ought  to  resign ; but  probably  he  knows  that  public  opinion  does  not 
require  more  of  him  than  he  performs,  that  if  he  did  all  that  he  knows 
should  be  done  it  would  require  all  of  his  time,  and  that  for  all  of  his  time 
he  can  earn  in  the  treatment  of  the  sick  at  least  one  thousand,  and  perhaps 
two  thousand  dollars  per  year. 

There  is  a law  of  supply  and  demand.  The  people  demand  and  pay  for 
their  treatment  when  sick.  They  do  not  yet  demand  that  much  of  the  sick- 
ness shall  be  prevented.  In  Pontiac  you  support  a number  of  good 
physicians  in  active  practice,  any  one  of  whom  would  probably  just  as  will- 
ingly serve  you  in  the  prevention  of  disease  as  in  treating  disease,  and  if  paid 
for  such  service,  the  best  one  among  them  would  soon  learn  to  prevent  as 
many  cases  as  he  now  treats.  Then  how  much  more  satisfactory  that  would 
be  to  all  concerned ! 

I am  a strong  believer  in  the  doctrine  of  conservation  of  energy — and  that 
no  worthy  effort  is  wasted.  I believe  that  good  has  resulted  in  Pontiac  from 
the  sanitary  convention  held  here  in  1883.  For  a time  after  that,  there  was 
a sanitary  association  here.  That  is  a good  thing  for  any  city.  But  to 
make  such  an  association  of  the  greatest  usefulness  there  must  be  connected 


118 


PONTIAC  SANITARY  CONVENTION,  OCT.,  1889. 


with  it  persons  who  have  a money  interest  in  sanitary  work.  It  will  not  do 
to  permit  the  heavy  burden  of  it  to  be  borne  by  a few  persons  who  have  no 
greater  pecuniary  interest  than  all  other  citizens  of  the  place.  Sanitary 
work  is  for  the  general  good  of  all,  and  all  should  contribute  to  its  support. 
The  only  way  in  which  this  is  practicable  is  through  a system  of  taxation  in 
the  most  equitable  way.  In  other  words  the  money  to  carry  out  the  sani- 
tary work,  which  your  local  association  shall  decide  is  necessary,  should 
come  out  of  the  general  fund  of  your  city,  or  a fund  similar  to  the  one  which 
pays  for  fire-protection  purposes.  In  some  cities,  a public  meeting  is  called 
each  year  to  decide  how  much  money  shall  be  raised  for  school  purposes; 
and  the  amount  voted  is  raised  by  taxation.  I would  recommend  that  a 
public  meeting  be  called  here  annually  to  decide  how  much  money  shall  be 
raised  for  health  and  life-protective  purposes,  and  that  at  such  meeting  the 
subject  of  this  paper  be  one  of  the  topics  discussed. 

I sincerely  hope  that  this  convention  will  put  new  life  into  your  local 
sanitary  association,  or  cause  a new  association  to  be  formed ; that  it  will 
cause  a public  meeting  in  the  interest  of  sanitary  progress;  that  you, will 
decide  to  pay  your  health  officer  such  a salary  as  will  compensate  him  for 
devoting  his  entire  time  to  your  service ; that  your  city  will  enter  more 
vigorously  upon  the  work  of  preventing  and  restricting  those  diseases  which 
we  know  so  well  how  to  restrict ; and  that  the  next  time  we  visit  Pontiac 
you  will  not  have,  as  you  now  have  here,  three  of  the  most  dangerous  of 
those  diseases;  in  fact  I look  forward  cheerfully  and  hopefully  to  the 
“good  time  coming ” when  sickness  and  premature  deaths  from  preventable 
causes  shall  have  ceased,  and  when  the  large  sums  of  money  heretofore 
wasted  paying  expenses  for  unnecessary  sickne^  and  funerals,  and  the  large 
sums  of  money  which  shall  be  earned  by  persons  whose  lives  have  been 
saved  through  sanitary  work,  shall  be  available  not  only  for  paying  for  the 
constant  services  of  Doctor  Gray  or  some  other  advanced  sanitarian  as  your 
health  officer,  and  for  such  other  sanitary  improvements  as  an  improved 
water-supply  and  a good  sewerage  system,  but  also  for  various  other  purposes 
which  shall  minister  to  the  well-being,  comfort  and  happiness  of  all  of  your 
people. 


